Effective airway management includes anticipating and planning for problems. Difficulties frequently occur as the result of patient characteristics that interfere with spontaneous breathing, bag mask ventilation, laryngoscopy, and/or intubation of the trachea. Identifying characteristics of the difficult airway and developing a plan for managing problems are essential principles of anesthesia practice [1]. These principles have been modified and effectively used to evaluate adults in the emergency department [2].

Children infrequently require aggressive airway management and difficulties do not often occur [3,4]. Many of the difficult airway predictors, particularly anatomic abnormalities, are more common in adults. As a result, evidence specific for children regarding identification and management of difficult airways is limited [5,6]. Nevertheless, a reasonable, systematic approach for children can be developed from experience with adult patients in the operating room and emergency department.

DEFINITION

A difficult airway is generally defined as a situation in which a clinician experiences difficulty with face mask ventilation, laryngoscopy, or intubation [1,2]. In an emergency setting, this also includes difficulty performing an emergency surgical airway, such as needle cricothyroidotomy.

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